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Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

Your Child

Antibiotic Resistance Rising in Kids with Urinary Tract Infections

2:00

Urinary Tract Infections (UTI) affect about 3 percent of children in the United States each year and account for more than 1 million visits to a pediatrician.

The most common cause of a UTI is the bacterium E.coli, which normally lives in the large intestine and are present in a child’s stool. The bacterium enters the urethra and travels up the urinary tract causing an infection. Typical ways for an infection to occur is when a child’s bottom isn’t properly wiped or the bladder doesn’t completely empty.

Problems with the structure or function of the urinary tract commonly contribute to UTIs in infants and young children.

UTIs are usually treated with antibiotics but a new scientific review warns that many kids are failing to respond to antibiotic treatment.

The reason, according to the researchers, is drug resistance following years of over-prescribing and misusing antibiotics.

"Antimicrobial resistance is an internationally recognized threat to health," noted study author Ashley Bryce, a doctoral fellow at the Center for Academic Primary Care at the University of Bristol in the U.K.

The threat is of particular concern among the younger patients, the authors said, especially because UTIs are the most common form of pediatric bacterial infections.

Young children are more vulnerable to complications including kidney scarring and kidney failure, so they require prompt, appropriate treatment, added Bryce and co-author Ceire Costelloe. Costelloe is a fellow in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, also in the U.K.

"Bacterial infections resistant to antibiotics can limit the availability of effective treatment options," ultimately doubling a patient's risk of death, they noted.

The study team reviewed 58 prior investigations conducted in 26 countries that collectively looked at more than 77,000 E. coli samples.

Researchers found that in wealthier countries, such as the U.S., 53 percent of pediatric UTI cases were found to be resistant to amoxicillin, one of the most commonly prescribed primary care antibiotics. Other antibiotics such as trimethoprim and co-amoxiclav (Augmentin) were also found to be non-effective with a quarter of young patients resistant and 8 percent resistant respectively.

In poorer developing countries, resistance was even higher at 80 percent, 60 percent respectively and more than a quarter of the patients were resistant to ciprofloxacin (Cipro), and 17 percent to nitrofurantoin (Macrobid)).

The study team said they couldn’t give a definitive reason about cause and effect but said the problem in wealthier countries probably relates to primary care doctors' routine and excessive prescription of antibiotics to children.

In poorer nations, "one possible explanation is the availability of antibiotics over the counter," they said, making the medications too easy to access and abuse.

"If left unaddressed, antibiotic resistance could re-create a world in which invasive surgeries are impossible and people routinely die from simple bacterial infections," they added.

In an accompanying editorial, Grant Russell, head of the School of Primary Health Care at Monash University in Melbourne, Australia, said the only surprise was the extent of the resistance and how many first-line antibiotics were likely to be ineffective.

If current trends persist, he warned, it could lead to a serious situation in which relatively cheap and easy-to-administer oral antibiotics will no longer be of practical benefit to young UTI patients. The result would be a greater reliance on much more costly intravenous medications.

The problem of antibiotic resistance for bacterial infections has been on the minds of scientist for some time now.  Cases are increasing at an unprecedented rate causing alarm and a call for more public education and due diligence on the part of physicians that prescribes antibiotics.

Story source: Alan Mozes, http://www.webmd.com/children/news/20160316/antibiotic-resistance-common-in-kids-urinary-tract-infections

 

 

Daily Dose

Medicine Dosing Errors

1:30 to read

How do you give your baby/toddler/child their medications? In a recent article in Pediatrics it was found that up to 80 percent of parents have made a dosing error when administering liquid medicine to their children.  The study looked at children eight years old or younger. 

 

In the study both English and Spanish speaking parents were asked to measure different amounts of liquid medicines using different “tools”, including a dosing cup, and different sized syringes. They also were given different instructions with either text only or text with pictures. The different dosing tools were labeled with either milliliters/teaspoon or milliliters only.  Lots of variables! 

 

Not surprising to me, the parents who used the texts/picture combination instructions and who also used the milliliter only labeled dosing tools had the lowest incidence of dosing errors.  When parents had to use any math skills to calculate the correct dosage there were more dosing errors.  Most dosing errors were also overdosing rather than under-dosing the liquid medications.

 

This was an important article not only for parents to realize that it is not uncommon to make an error when giving their child medication, but also for doctors who write the prescriptions.  Before electronic medical records and “e-prescribing” I would typically write medication instructions in milliliters and teaspoons…in other words “take 5ml/1 tsp by mouth once daily”.  With electronic record you can only make one dosing choice which I now do in milliliters. But, with that being said, I still get phone calls from parents asking “how many teaspoons is 7.5 ml?”.

 

Previous studies have also shown numerous dosing errors when parents use kitchen teaspoons and tablespoons to try and measure their child’s medication. 

 

Some over the counter drug makers have tried to cut down on dosing errors with their liquid medications by making all of their products, whether for infants or children, the same strength. The only difference is the dosing tool that accompanies the medicine (syringe vs cup).  Interestingly, these medications may have a price difference when they are actually the same thing.  

 

This study may help to find strategies for comprehensive labeling/dosing for pediatric liquid medications, which will ultimately reduce errors.  Stay tuned for more!

 

 

 

 

 

Your Child

Flavored Spray May Help Pills Go Down A Little Easier!

1:45

When your child is sick, chances are you have a difficult time getting him or her to swallow their prescription pills. It’s a problem parents and caregivers have in common- getting a child’s medication into their body. Liquids typically come in several flavors, which can be helpful, but pills are another matter.

Some pills are tiny and smooth – making the job easier. But others can be large powdery and oddly shaped. To make things worse, they may need to be taken throughout the day. So, what’s a parent to do?

The results of a small study may be just what the doctor ordered. Researchers have found that a flavored spray, called Pill Glide, may make pill taking a lot more flavorful -- and maybe even enjoyable.

"There was a significant decrease in the difficulty of taking medicine with these sprays," said Dr. Catherine Tuleu, a pharmaceuticals researcher at University College London, who conducted the research with colleagues at Great Ormond Street Hospital in the UK. "The kids liked to be in charge and to change the flavor."

What is Pill Glide? It’s a spray that is squirted into the mouth to lubricate and add flavor to tablets and capsules to make them easier to swallow. It's available in five flavors: strawberry, peach, grape, bubble gum and orange, with strawberry coming through as the favorite in the trial. Its ingredients include artificial flavors and sweeteners. This spray was used in the trial study with results published in the journal Pediatrics.

Tuleu and her team tried it among 25 children ages 6 to 17 that were receiving long-term therapies for HIV or organ transplants and who were transitioning from liquid medication to solids or were known to struggle with swallowing pills.

Keeping diaries, the study participants used a six-point scale to note the levels of difficulty they experienced when taking their regular tablets for two weeks and then using the Pill Glide sprays for one week. The final analysis was conducted on 10 children who had kept complete diary entries.

The flavored sprays were found to decrease the level of difficulty by a score of 0.93, almost one full level on the scale used by the team.

"The swallowing of medicine in the form of pills often poses a real challenge for a good many children, making this study of definite interest," said Dr. Laura Jana, a pediatrician and director of innovation at the University of Nebraska Medical Center College of Public Health, who was not involved in the research. "Something as seemingly simple as improving the taste and ease of swallowing a pill can have a significant impact on the proper and effective use of medicines."

The trial was very small and limited especially when you look at the number of participants, their health issues and the age group. But it may still be a process worth considering.

Tuleu acknowledges these limitations, and in addition to trying Pill Glide among larger groups, she wants to test its benefits in children who are less familiar with taking pills and who start out on solid pills, rather than transitioning from liquids.

"It would be interesting to try it with more naïve patients," she said. "If swallowing is not the challenge anymore, giving medication could be a lot easier."

Will this product make it easier for all kids to take a pill? Probably not. But this new approach may help some kids get past their difficulty with swallowing larger, more uncomfortable pills. It’s worth a try!

Story source: Meera Senthilingam, http://www.cnn.com/2016/11/01/health/kids-swallowing-pills-spray/

Daily Dose

Treating Scabies

There has been an outbreak of scabies recently. Here's how to treat it.I received an email via our iPhone App from a mother whose 6 year old son had scabies and had been treated two times with permethrin cream, but had just had another re-occurrence.  She wondered if there were any other options for treatment.

Scabies is a mite that causes an eczematous skin rash with associated horrible itching. Infestation with the scabies mite is the result of skin to skin contact.  The mite burrows beneath the skin and the feces of the mite causes an allergic hypersensitivity reaction with resulting skin inflammation and itching. It can be fairly miserable when it goes on for awhile. (Once again my own son had it 20 years ago and that was actually one of the first times I had seen the rash of scabies and it took 3 different doctors including an allergist to finally diagnose it! ). It is sometimes easily diagnosed as a child will have a classic rash on their, trunk, arms and legs, and may even has the classic burrow tract of the mite between their toes and fingers. At other times scabies can be a great masquerader and the diagnosis may be made by scraping the skin and looking at it under the microscope where the actual mite or mite parts may be seen. If in doubt it is always a good idea to do a scraping. The time from infestation with the mite to actually symptoms may be as long as 6 weeks. During this time the “index” case in a family harbors the mites and are infectious, but they may not yet be symptomatic with the typical rash of scabies. When you diagnose a child with scabies the most important thing to do is to not only treat the child but treat the entire family unit.  Because the mite has such a long infectious incubation period it is important to treat all family members at the same time.  The standard treatment is with 5% permethrin cream, which is typically applied at night to all body surfaces from neck to toes. (do not bath before putting on the cream as this will help reduce the systemic absorption of the medicine). Make sure to get the cream between the web spaces of the fingers and toes.  The cream is left on over night (remember entire family) and then washed off in the am.  The next day I would wash all of the clothes and sheets in hot water.  If there are clothing that will not tolerate this put them in a platic bag for 72 hours (which is the life span of the mite off of the body). Even after a patient is successfully treated the itching may continue for several more days and may be treated with topical steroid cream (Cortaid over the counter or a prescription steroid cream).  What you will notice is that while the intense itching is diminishing, there are no NEW areas of rash. Most treatment failures seem to be due to not applying the cream with attention to complete coverage,  or to not treating the entire family at the same time. Another medication Lindane (Kwell) has been used to treat scabie,  but has been associated with the potential for neurotoxicity and is rarely prescribed, especially for younger children. There is also an antiparasitic medication, Ivermectin that is currently being studied for the treatment of scabies. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Cold Season is Here

School starts and colds start almost simultaneously no matter how old your child is.School starts and colds start almost simultaneously. It even amazes me to see kids with their first cold of the season within 15 minutes of starting school, whether it is Mother's Day Out or high school, it affects every age.

The worst part of a having a cold is knowing that it is going to last seven to 10 days, no matter what you do. The old adage of rest, fluids and nasal irrigation is still the mainstay of treatment. Remember that over the counter cough and cold medicines are not recommended for use in children under the age of 2 and really are not very effective in the overall scheme of things. There has been some renewed interest in zinc and reduction of symptoms and decreased duration of colds so stay tuned for more info on that. In the meantime, keep up hand washing and good cough hygiene to try and prevent getting one of the first colds of the season. That's your daily dose, we'll chat tomorrow!

Daily Dose

Codeine & Children

1:30 to read

I order to keep us all safe, the FDA is constantly monitoring drugs and their side effects.  For many years codeine was prescribed for children for pain relief as well as to suppress coughs.  Over the last few years there has been more and more discussion about limiting the use of narcotics in children, but I continue to see some children who come from seeing other physicians and have received a prescription that contains codeine.

 

The FDA just issued new warnings against using prescription codeine in children and adolescents. The FDA reviewed adverse event reports from the past 50 years and found reports of severe breathing problems and 24 deaths linked to codeine in children and adolescents. Genetic variation in codeine metabolism may lead to excessive morphine levels in some children.

 

The FDA also performed a literature review which noted excessive sleepiness and breathing problems, including one death, in breast-fed infants whose mothers used codeine.

 

Due to these findings the FDA is now recommending that “codeine should not be used for pain or cough in children under 12 years of age”. They have also issued a warning that codeine should not be used in adolescents aged 12-18 “who are obese or have conditions associated with breathing problems, such as obstructive sleep apnea or severe lung disease”. In retrospect, codeine was prescribed to more than 800,000 children younger than11 years in 2011. Amazingly, codeine is currently available in over-the-counter cough medicines in 28 states.  

 

Lastly, the FDA “strengthened the warning” regarding codeine and breast feeding. They now recommend that breast- feeding women do not use codeine…which may change the post delivery pain protocol. Nonsteroidal anti-inflammatories (Ibuprofen) and acetaminophen (Tylenol) are preferred and are effective for mild to moderate postpartum pain. As a pediatrician it is important that I discuss this with new breast-feeding mothers as well. 

Daily Dose

Confusion Over Cough & Cold Medicines

Why are so many parents confused about cough and cold medicines?The confusion over cough and cold medications continues and I must admit I am a little confused too.

The Consumer Healthcare Products Association announced changes to the labeling of over-the-counter (OTC) cold products to state “do not use in children under 4 years of age”. The FDA monograph still states “do not use in children under 2 years”. The American Academy of Pediatrics recommends not using OTC cough and cold preparations in children under six years. Looking at the little research on these products two things come to mind: 1.  There have been multiple studies done on these products (in adults) that do not show them to be efficacious for treating common cough and cold symptoms. 2.  The research among children using these products show that dosing errors and accidental ingestions are the leading cause of adverse events. This kind of leaves me thinking why use them at all in children? I really have never been much of a cold medicine giver in general, as I personally did not see my patients getting better any faster nor my own children. We continued to use the good old grandmother tested remedies of lots of rest, fresh squeezed orange juice (sometimes in pays to be sick), chicken noodle soup (canned or home made), and a vaporizer or humidifier in their rooms at night. I also know that younger children get more colds than anyone and no matter what you do you have to get through that too. But miraculously, as kids get older they get less colds and seem to tolerate them a little better. So… for this winter in our practice we are not recommending the use of any of these products for kids and trying the gold standards rest, fluids, cool mist humidifier and tincture of time. We’ll see how it goes. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Asthma

1:30 to read

May is Asthma Awareness Month and I am certainly seeing many patients whose asthma and wheezing is getting the best of them right now. With all of the major weather changes across the country, pollen counts through the roof, and upper respiratory viruses still circulating, there are quite a few triggers to set off wheezing.

 

Asthma is a chronic lung disease and affects more than 6 million children in the United States. Asthma causes wheezing and chest tightness in some, while it may only cause nighttime cough and cough with exercise in others. There is not one single presentation to asthma and the diagnosis is best made with a good history and physical exam.  Although asthma is a chronic disease you may only have attacks when something is bothering your lungs (triggers).

 

The biggest challenge I see as a pediatrician is teaching both parents and children to recognize their triggers and to know what their medications are. Every patient should have an asthma action plan, but in some cases, a child may have only wheezed once..and their parents received an inhaler or a nebulizer but really does not know what to do if their child wheezes again.

 

If your child has wheezed before, and you have a family history of wheezing, your child has a greater chance of wheezing again.  You should have a discussion with your pediatrician about how to recognize wheezing in your child. At the same time, if you have ever received a medication for wheezing, make sure you know the name or names of the medication. I see many parents who come in to the office and they may have been seen at an ER or urgent care when they were noted to be wheezing. They received an “inhaler”, but the parent has no clue as to the name of the inhaler (they may say, “it is blue”), and they don’t understand how the medications work.

 

The two points I try to make with every patient I see with wheezing:  

#1  Know the names of the medications that you have

#2  Know what the medications do

 

There are two issues with asthma, lung inflammation and broncho spasm (narrowing of the airways). So…there are two medications commonly used to treat these issues.  Inhaled steroids (there are tons of brands) are used as a preventative and decrease inflammation, while albuterol (again tons of brands) is a broncho-dilator and opens up the narrowed airways.  I see too many patients that bring in a bag full of medications, from numerous doctors and still don’t understand what their medications are used for, when to use them and that several of their inhalers, while having different names, are actually the same medicine.

 

Lastly, children with divorced parents need to have inhalers available at both homes. I think it is too complicated to try and have parents hand the inhaler or medication back and forth and think they will not forget or lose the medication.  Ask your doctor to have meds for both houses.

Seeing that is is Asthma Awareness month, get your medications out and make sure that they are not expired and if you don’t understand how or when to use them, make an appointment with your pediatrician and get an asthma action plan in place. Be prepared!  

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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